37226 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed

Name of the Procedure:

Revascularization, Endovascular, Open or Percutaneous, Femoral, Popliteal Artery(s), Unilateral; with Transluminal Stent Placement(s) (commonly referred to as femoral-popliteal stenting or revascularization with stenting)

Summary

This procedure involves opening up narrowed or blocked femoral and popliteal arteries in one leg using a stent, a small mesh tube. The stent keeps the artery open and improves blood flow. The procedure can be done using minimally invasive techniques or through a small surgical incision.

Purpose

The procedure is designed to treat peripheral artery disease (PAD), a condition where the arteries in the legs become narrowed or blocked. The primary goal is to restore proper blood flow to alleviate symptoms such as leg pain and improve the patient's ability to walk and perform daily activities.

Indications

• Symptoms like leg pain (claudication), especially when walking
• Rest pain in the lower limb
• Non-healing wounds or ulcers on the legs or feet
• Severe peripheral artery disease (PAD) confirmed by diagnostic tests

Preparation

• Patients may need to fast for several hours before the procedure.
• Blood tests and imaging studies like an ultrasound or angiography may be performed.
• Certain medications, especially blood thinners, may need to be adjusted or paused.
• Patient consent and pre-procedure instructions will be discussed with the healthcare team.

Procedure Description

1. Preparation and Anesthesia: The patient is given local anesthesia with sedation, or in some cases, general anesthesia.
2. Accessing the Artery: A small incision is made, usually in the groin area, to access the femoral artery.
3. Inserting the Catheter: A catheter, which is a thin tube, is inserted into the artery and guided to the blockage.
4. Angioplasty: A balloon attached to the catheter is inflated to widen the narrowed portion of the artery.
5. Stent Placement: A stent is placed into the artery at the site of the blockage to keep it open.
6. Final Checks: Imaging techniques are used to confirm the stent's proper placement and adequate blood flow.

Duration

The procedure typically takes 1 to 3 hours, depending on the complexity and the patient's condition.

Setting

This procedure is usually performed in a hospital's catheterization lab or surgical center.

Personnel

• Vascular surgeon or interventional radiologist
• Anesthesiologist or nurse anesthetist
• Scrub nurse and circulating nurse
• Technicians to operate imaging equipment

Risks and Complications

• Bleeding at the catheter insertion site
• Blood clots or embolism
• Infection
• Stent migration
• Artery damage
• Allergic reaction to contrast dye
• Rarely, stroke or heart attack

Benefits

• Improved blood flow to the leg
• Alleviation of pain and other symptoms related to PAD
• Enhanced mobility and quality of life
• Faster recovery compared to open surgery

Recovery

• Patients might stay in the hospital for observation overnight.
• Instructions on wound care and physical activity will be provided.
• Follow-up appointments to monitor recovery and stent function.
• Restrictions on strenuous activities for a few weeks.
• Blood thinners or antiplatelet medication may be prescribed.

Alternatives

• Medication (e.g., anti-platelets and statins)
• Lifestyle changes (e.g., exercise, smoking cessation)
• Alternative procedures like bypass surgery or atherectomy
• Each alternative comes with its own set of risks, benefits, and recovery timelines.

Patient Experience

During the procedure, patients might feel some pressure but usually no pain if under local anesthesia with sedation. Post-procedure, the insertion site may feel sore, and mild pain can be managed with prescribed painkillers. Steps are taken to ensure patient comfort throughout the process.